Understanding Chronic pain

One needs to understand what chronic pain is. Chronic pain persists over a long period of time and is usually resistant to medical treatment. Acute pain, is a response to a specific injury, and is usually treatable.

Chronic pain can be related to a number of medical conditions, diabetes, arthritis, migraine, fibromyalgia, cancer, shingles, sciatica and from previous trauma or injury. Environmental and/or psychological factors, chronic pain can worsen.

Pain management is there to provide relief of pain and improve an individual’s level of functioning in daily activities.

There are a number of medications that have been used in pain management. These are acetaminophen, ibuprofen, aspirin, COX-S inhibitors, anti-migraine medications, sedatives, opioids, and antidepressants.

There is nonmedical treatment in pain management. These include exercise, physical therapy, counselling, electrical stimulation, biofeedback, acupuncture, hypnosis, chiropractic medicine, and other treatment.

SOURCE:
MedTerms.com. Chronic pain

Chronic pain usually is accompanied by other symptoms that result from the continual pain. These can include insomnia or poor quality sleep, irritability, depression which includes mood changes, anxiety, fatigue and a loss of interest in daily routine. Pain can also trigger muscle spasms that will lead to soreness or stiffness.

This is a very interesting bit of information. Pain can become worse because of a “wind-up phenomenon” that causes untreated pain to get worse. Nerve fibres transmitting the painful impulse to the brain actually become “trained” to deliver pain signals better.

The intensity of the signals increase well above the need to get the person’s attention and to make matters worse the brain becomes more sensitive to the pain. In other words, the pain worsens though the injury or illness has not progressed. In other words, this signal is no longer helpful.

The goal when a patient consults a doctor is that the cause of their pain is found so a cure can be found, so the patient can resume a normal life, without being on medication or further professional health care.

There are many illnesses that have no know cures, especially illnesses such as diabetes and high blood pressure which is usually long time illnesses. Medication is often needed for the rest of the person life.

Understanding that chronic pain is no different from diabetes or high blood pressure. A person cannot be said to be addictive because they need pain medicine for the rest of their lives any more than a diabetic could be said to be addicted to insulin. 

The brain localises pain that is from the skin or muscles, this is somatic pain, and that pain is usually resolved quiet quickly. Somatic pain can be treated with non-steroidal anti-inflammatory drugs such as ibuprofen or naproxen or with Tylenol, sometimes opioids can be used.

Some people that develop pain that never goes away, fibromyalgia and chronic back pain full into this category.

Depending where the pain originates from can makes it difficult for a person pinpoint where exactly is the pain. The connections from pain sensor in the internal organs to the brain are less sophisticated than the nerve connections from the skin and muscles. Gallbladder problems can cause pain to the right shoulder. Visceral pain is from acid indigestion or constipation and very easy to recognise. Visceral pain is very easy to treat with over the counter medication. Visceral pain from gallstones or appendicitis can be treated with surgery.

Pain in the bones from a bruise or a fracture is temporary. Pain from bone cancer, osteoporosis (softening of the bones that often appears in older people), osteomyelitis (an infection in a bone), or arthritis (inflammation of the joints) can last a long time. 

Muscle spasm, such as charley horse or cramp, can cause severe pain especially in the back. Pain medication alone may not be able to resolve the pain. Muscle relaxants such as cyclobenzaprine (Flexeril) or baclofen (Lioresal) may be needed to relax the muscles 

All pain comes from nerves. Nerves transmit painful impulse to the brain. Not all pain arrives from nerve ending but from irritation along the length of the nerve. Sciatica is caused by the pinching of the sciatic nerve, which goes from the leg to the spine. The pinching takes place near the lower part of the spine but the pain is perceived as coming from the nerve ending in the leg as the pain is usually felt in the legs. 

This is called peripheral neuropath. Another peripheral neuropath is from ruptured discs in the spines, which pinches nerves. Common diseases that often cause peripheral neuropathy are diabetes and AIDS. 

Nerve pain can feel like a painful "pins and needles" sensation. This kind of nerve pain can be treated with tricyclic antidepressants. Other, more severe nerve pain can be described as a sharp, stabbing, electric feeling. Anti-convulsants (medicines that treat seizures) can be used for this kind of nerve pain.

Some nerve pain is due to loss of a limb. The arm or leg that has been amputated feels like it's still present, and hurts severely. This kind of nerve pain, called differentiation, or "phantom limb pain," can be treated with clonidine (Catapres) (a blood pressure medicine that also relieves nerve pain).